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Quality of life after surgery of the alimentary tract

World Journal of Gastroenterology 2010年第40期16卷 5020-5023页

作者： marco scarpa Department of Oncological Surgery Venetian Oncology Institute (IOV-IRCCS)

In recent decades, patient-reported outcomes have become important in clinical medicine. Nowadays, health-related quality of life (HRQOL) is considered a primary outcome in many clinical trials, and it is often the major criterion for judging treatment success. At the beginning of the 21st century, morbidity and mortality rates after surgery of the alimentary tract have dropped dramatically and they can no longer be considered the only outcome measures to determine the success of a surgical procedure. QOL can yield a definitely more patient-orientated measure of outcome that provides us with a more formal measure of the patient’s judgment and desires, which can influence treatment decisions. Nevertheless, despite a very large number of published papers on HRQOL, there is some skepticism on the value of HRQOL and other patientrelated outcomes. Therefore, this topic highlight aims to assess how QOL after surgery of the alimentary tract is covered in the medical literature. Different reviews have analyzed the topic according to different points of view: benign and malignant disease; curative and palliative treatment; open and minimally invasive surgical approach; traditional and newly introduced surgical procedures. This topic highlight does not aim to cover all the possible diseases or different surgical procedures, but it does describe the different approaches in order to give the reader a broad spectrum of analysis of QOL after surgery. This quick overview could stimulate the reader to form his/her own opinion about how to use this primary outcome measure.

关键词： Patient-reported outcomes Health-related quality of life Esophageal cancer Gallbladder stones Ulcerative colitis Crohn’s disease Colonic diverticular disease Colorectal cancer Rectal prolapse

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World Journal of Gastroenterology 2010年第32期16卷 4013-4018页

作者： Imerio Angriman marco scarpa Cesare Ruffolo Department of Surgical and Gastroenterological Sciences University of PadovaVia Giustiniani 2Padova 35128Italy Department of Surgery Veneto Oncological Institute(IOV-IRCCS)Via Giustiniani 2Padova 35128Italy Department of Surgery(IV unit) Regional Hospital Cà FoncelloPiazza Ospedale 1Treviso 31100Italy

Diverticular disease(DD) of the colon is very common in developed countries and is ranked the fifth most important gastrointestinal disease *** management of acute diverticulitis without perforation and peritonitis is still *** related quality of life(HRQL),subjectively perceived by patients,is becoming a major issue in the evaluation of any therapeutic intervention,mainly in patients with chronic *** date only a few published studies can be found on Medline examining HRQL in patients with *** aim of this study was to review the impact of surgery for DD on *** Medline articles regarding HRQL after surgery for colonic DD,particularly those comparing different surgical approaches,were *** has a negative impact on HRQL with lower scores in bowel function and systemic *** surgery-related complications and disease activity have a significant impact on patients' *** no signif icant differences in HRQL between different operations for DD in non-randomized studies were revealed,the only prospective double-blind randomized study that compared laparoscopic and open colectomy found that patients undergoing laparoscopic colectomy had signif icantly reduced major postoperative complication rates and subsequently had better HRQL *** assessment of HRQL could be a good instrument in the selection of appropriate patients for elective surgery as well as in the assessment of surgical outcome.

关键词： Colonic diverticular disease Health related quality of life Laparoscopy

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Relationship between pouch microbiota and pouchitis following restorative proctocolectomy for ulcerative colitis

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World Journal of Gastroenterology 2014年第29期20卷 9665-9674页

作者： Imerio Angriman marco scarpa Ignazio Castagliuolo Department of Surgery Gastroenterology and OncologyUniversity of Padova Surgical Oncology Unit Veneto Institute of Oncology (IOV-IRCCS) Department of Molecular Medicine University of Padova

Restorative proctocolectomy with ileal pouch-anal anastomosis(IPAA)has become the surgical treatment of choice for many patients with medically refractory ulcerative colitis(UC)and familial adenomatous polyposis(FAP).UC patients with IPAA(UC-IPAA)are,nevertheless,susceptible to inflammatory and noninflammatory sequelae such as pouchitis,which is only rarely noted in FAP patients with *** is the most frequent long-term complication of UC-IPAA patients,with a cumulative prevalence of up to 50%.Although the aetiology of pouchitis remains unclear,accumulating evidence suggests that a dysbiosis of the pouch microbiota and an abnormal mucosal immune response are implicated in its *** using culture and molecular techniques have detected a dysbiosis of the pouch microbiota in patients with *** factors,genetic associations,and serological markers suggest that interactions between the host immune response and the pouch microbiota underlie the aetiology of this idiopathic inflammatory *** systematic review focuses on the dysbiosis of the microbiota that inhabit the pouch in UC and FAP patients and its interaction with the mucosal immune system.A metaanalysis was not attempted due to the highly heterogeneous microbiota composition and the different detection methods used by the various *** no specific bacterial species,genus,or family has as yet been identified as pathogenic,there is evidence that a dysbiosis characterized by decreased gut microbiota diversity in UC-IPAA patients may,in genetically predisposed subjects,lead to aberrant mucosal immune regulation triggering an inflammatory process.

关键词： Pouchitis Inflammation of the ileal pouch Microbiota Bacteria Microbiome Ileal-pouch-anal anastomosis Ulcerative colitis Crohn's disease Inflammatory bowel disease

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Perianal Crohn's disease: Is there something new?

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World Journal of Gastroenterology 2011年第15期17卷 1939-1946页

作者： Cesare Ruffolo Marilisa Citton marco scarpa Imerio Angriman marco Massani Ezio Caratozzolo Nicolò Bassi Ⅱ Department of Surgery (IV unit) Regional Hospital Ca' Foncello 31100 Treviso Italy Department of Surgicaland Gastroenterological Sciences University of Padova 35122 Padua Padova Italy Department of Oncological Surgery VenetoOncological Institute 35100 Padova Italy Department of Surgicaland Gastroenterological Sciences University of Padova 35122Padua Padova Italy

Perianal lesions are common in patients with Crohn's disease, and display aggressive behavior in some cases. An accurate diagnosis is necessary for the optimal management of perianal lesions. Treatment of perianal Crohn's disease includes medical and/or surgical options. Recent discoveries in the pathogenesis of this disease have led to advances in medical and surgical therapy with good results. Perianal lesions in Crohn's disease remain a challenging aspect for both gastroenterologists and surgeons and lead to a greatly impaired quality of life for all patients affected by this disease. A multidisciplinary approach is mandatory to obtain the best results.

关键词： Crohn disease Diagnosis Biologic therapy Surgery Rectal fistula

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Inflammatory colonic carcinogenesis: A review on pathogenesis and immunosurveillance mechanisms in ulcerative colitis

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World Journal of Gastroenterology 2014年第22期20卷 6774-6785页

作者： marco scarpa Ignazio Castagliuolo Carlo Castoro Anna Pozza Melania scarpa Andromachi Kotsafti Imerio Angriman Surgical Oncology Unit Veneto Institute of Oncology (IOV-IRCCS)35128 PadovaItaly Department of Molecular Medicine University of Padova35128 PadovaItaly Department of Surgery Gastroenterology and OncologyUniversity of Padova35128 PadovaItaly

Ulcerative colitis(UC)is characterized by repeated flare-ups of inflammation that can lead to oncogenic insults to the colonic ***-associated carcinogenesis presents a different sequence of tumorigenic events compared to those that contribute to the development of sporadic colorectal *** fact,in UC,the early events are represented by oxidative DNA damage and DNA methylation that can produce an inhibition of oncosuppressor genes,mutation of p53,aneuploidy,and microsatellite *** of tumor suppressor and DNA mismatch repair gene promoter regions is an epigenetic mechanism of gene silencing that contribute to tumorigenesis and may represent the first step in inflammatory ***,p53 is frequently mutated in the early stages of UC-associated *** is an independentrisk factor for forthcoming carcinogenesis in *** cell-T-cell cross-talk mediated by CD80 is a key factor in controlling the progression from low to high grade dysplasia in UC-associated carcinogenesis.

关键词： Colorectal cancer Ulcerative colitis Carcinogenesis Immune surveillance

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Impact of jejunostomy during esophagectomy for cancer on health related quality of life

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Chinese Journal of Cancer Research 2014年第6期26卷 678-684页

作者： marco scarpa Francesco Cavallin Giulia Noaro Eleonora Pinto Rita Alfieri Matteo Cagol Carlo Castoro Surgical Oncology Unit Veneto Institute of Oncology (IOV-IRCCS) Padua 35128 Italy

Background： The aim of this study was to evaluate the impact of jejunostomy during esophagectomy for cancer on postoperative health-related quality of life（HRQL）.Methods： We evaluate all consecutive patients who underwent esophagectomy for cancer at the surgical oncology unit of the Veneto Institute of Oncology（IOV-IRCCS） between January 2008 and March 2014. The primary outcome was HRQL, which was assessed using nine scales of EORTC C30 and OES18 questionnaires. General linear models were estimated to evaluate mean score difference（MD） of each selected scale in patients with and without jejunostomy, adjusting for clinically relevant confounders. The secondary outcomes were morbidity, hospital stay, postoperative weight loss and postoperative albumin impairment. Results： Jejunostomy was performed in 40 on 109 patients（41.3%） who participated in quality of life investigation. A clinically and statistically significantly worse eating at admission（P=0.009） became not clinically significant at 3 months after surgery（MD =9.1）. Jejunostomy was associated to clinically and statistically significantly poorer emotional function（EF） at 3 months after surgery（MD =-15.6; P=0.04）. Hospital stay was longer in jejunostomy group（median, 20 vs. 17 days, P=0.02）.Conclusions： In our series patients who had a jejunostomy during esophagectomy had been selected for their risk for postoperative complication. However, their postoperative outcome was actually similar compared to those without jejunostomy. Nevertheless, jejunostomy was associated to clinically and statistically significantly poorer EF at 3 months after surgery. Therefore, patient candidate to esophagectomy and feeding jejunostomy should receive additional psychological support.

关键词： Health-related quality of life(HRQL) jejunostomy esophagectomy esophageal cancer

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Quality of life in patients with esophageal stenting for the palliation of malignant dysphagia

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World Journal of Gastroenterology 2011年第2期17卷 144-150页

作者： Giorgio Diamantis marco scarpa Paolo Bocus Stefano Realdon Carlo Castoro Ermanno Ancona Giorgio Battaglia Veneto Oncological Institute(IOV-IRCCS) Department of Surgical and Gastroenterological Sciences University of Padua

Diamantis G, scarpa M, Castoro C, Ancona E and Battaglia G designed the research; Diamantis G, scarpa M, Bocus P, Realdon S and Castoro C performed the research; Castoro C, Ancona E and Battaglia G contributed analytic tools; Diamantis G, scarpa M, Bocus P, Realdon S and Castoro C analyzed the data; Diamantis G and scarpa M wrote the paper; all authors revised and approved the final version of the manuscript.

关键词： Esophageal cancer Health-related quality of life Self-expandable metal stents

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Systematic review of health-related quality of life after esophagectomy for esophageal cancer

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World Journal of Gastroenterology 2011年第42期17卷 4660-4674页

作者： marco scarpa Stefano Valente Rita Alfieri Matteo Cagol Giorgio Diamantis Ermanno Ancona Carlo Castoro Oncological Surgery Unit Veneto Institute of Oncology Department of Gastroint estinal and Surgical Sciences University of Padova

This study is aimed to assess the long-term healthrelated quality of life （HRQL） of patients after esophagectomy for esophageal cancer in comparison with established norms, and to evaluate changes in HRQL during the different stages of follow-up after esophageal resection. A systematic review was performed by searching medical databases （Medline, Embase and the Cochrane Library） for potentially relevant studies that appeared between January 1975 and March 2011. Studies were included if they addressed the question of HRQL after esophageal resection for esophageal cancer. Two researchers independently performed the study selection, data extraction and analysis processes. Twenty-one observational studies were included with a total of 1282 （12-355） patients. Five studies were performed with short form-36 （SF-36） and 16 with European Organization for Research and Treatment of Cancer （EORTC） QLQ c30 （14 of them also utilized the disease-specific OESI8 or its previous version OES24）.The analysis of long-term generic HRQL with SF-36 showed pooled scores for physical, role and social function after esophagectomy similar to United States norms, but lower pooled scores for physical function, vitality and general health perception. The analysis of HRQL conducted using the Global EORTC C30 global scale during a 6-mo follow-up showed that global scale and physical function were better at the baseline. The symptom scales indicated worsened fatigue, dyspnea and diarrhea 6 mo after esophagectomy. In contrast, however, emotional function had significantly improved after 6 mo. In conclusion, short- and long-term HRQL is deeply affected after esophagectomy for cancer. The impairment of physical function may be a long-term consequence of esophagectomy involving either the respiratory system or the alimentary tract. The short- and long-term improvement in the emotional function of patients who have undergone successful operations may be attributed to the impression that they have survive

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Antioxidative potential of a combined therapy of anti TNFα and Zn acetate in experimental colitis

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World Journal of Gastroenterology 2011年第36期17卷 4099-4103页

作者： Michela Barollo Valentina Medici Renata DIncà Antara Banerjee Giuseppe Ingravallo marco scarpa Surajit Patak Cesare Ruffolo Romilda Cardin Giacomo Carlo Sturniolo Department of Surgical and Gastroenterological Sciences University of PadovaPadova 35128Italy Department of Internal Medicine Division of Gastroenterology and HepatologyUniversity of CaliforniaDavisCA 95616United States Department of Pathology University of BariBari 70121Italy Department of Oncological Surgery Veneto Oncological InstitutePadova 35128Italy

AIM:To evaluate whether combination therapy with antitumour necrosis factor α (TNFα) antibody and Zn acetate is beneficial in dextran sodium sulphate (DSS) ***:Colitis was induced in CD1-Swiss mice with 5% DSS for 7 *** experimental mice were then randomised into the following subgroups:standard diet + DSS treated (induced colitis group);standard diet + DSS + subcutaneous 25 μg anti-TNFα treated group;Zn acetate treated group + DSS + subcutaneous 25 μg anti-TNFα;standard diet + DSS + subcutaneous 6.25 μg anti-TNFα treated group and Zn acetate treated group + DSS + subcutaneous 6.25 μg anti-TNFα.Each group of mice was matched with a similar group of sham control *** and histological features were scored *** of the colonic mucosa were assessed for myeloperoxidase activity as a biochemical marker of inflammation and DNA adducts (8OH-dG) as a measure of oxidative ***:DSS produced submucosal erosions,ulcers,inflammatory cell infiltration and cryptic abscesses which were reduced in both groups of mice receiving either anti-TNFα alone or combined with *** effect was more pronounced in the latter group (vs Zn diet,P < 0.02).Myeloperoxidase activity (vs controls,P < 0.02) and DNA adducts,greatly elevated in the DSS fed colitis group (vs controls,P < 0.05),were significantly reduced in the treated groups,with a more remarkable effect in the group receiving combined therapy (vs standard diet,P < 0.04).CONCLUSION:DSS induces colonic inflammation which is modulated by the administration of anti-TNFα.Combining anti-TNFα with Zn acetate offers marginal benefit in colitis severity.

关键词： Anti tumor necrosis factor α Experimental colitis Inflammatory bowel disease Oxidative damage Zinc

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Persistence of high CD40 and CD40L expression after restorative proctocolectomy for ulcerative colitis

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World Journal of Gastroenterology 2005年第34期11卷 5303-5308页

作者： Lino Polese Imerio Angriman Giuseppe De Franchis Attilio Cecchetto Giacomo C.Sturniolo Renata D'Incà marco scarpa Cesare Ruffolo Lorenzo Norberto Mauro Frego Davide F D'Amico Department of Gastroenterological and Surgical Sciences. Surgical Unit University of Padova Italy Department of Laboratory Medicine University of Padova Italy Department of Pathology University of Padova Italy Department of Gastroenterological and Surgical Sciences Gastroenterological Unit University of Padova Italy

AIM： To focus on the role of CD40 and CD40L in their pathogenesis. METHODS： We analyzed by immunohistochemistry the CD40 and CD40L expression in the pouch mucosa of 28 patients who had undergone RPC for UC, in the terminal ileum of 6 patients with UC and 11 healthy subjects. We also examined by flow cytometry the expression of CEH0 by B lymphoo/tes and monocytes in the peripheral blood of 20 pouch patients, 15 UC patients and 11 healthy controls. RESULTS： Ileal pouch mucosa leukocytes presented a significantly higher expression of CD40 and CD40L as compared to controls. This alteration correlated with pouchitis, but was also present in the healthy pouch and in the terminal ileum of UC patients. CD40 expression of peripheral B lymphocytes was significantly higher in patients with UC and pouch, respect to controls. Increased CD40 levels in blood B cells of pouch patients correlated with the presence of spondyloarthropathy, but not with pouchitis, or inflammatory indices. CONCLUSION： High CD40 expression in the ileal pouch mucosa could be implied in the pathogenesis of pouchitis following proctocolectomy for UC, whereas its increased levels on peripheral blood B lymphocytes are associated with the presence of extraintestinal manifestations.

关键词： Ulcerative colitis Pouchitis Spondyloarthropathy CD40 CD4OL Arthritis

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